SUMMARY IMPROVING EARLY CHILDHOOD DEVELOPMENT: WHO Guideline GLOSSARY OF TERMS Attachment An emotional bond between an infant and one or more adults. The infant will approach these individuals in times of distress, particularly during the phase of infant development when the presence of strangers induces anxiety. In addition, the infant is distressed if separated from attachment figures. Depression An affective disorder characterized by a sense of inadequacy, feelings of despondency or hopelessness, a decrease in activity and/or reactivity, pessimism, sadness, irritability, changes in appetite and sleep patterns, and poor concentration. Developmental potential Ability to think, learn, remember, relate and articulate ideas appropriate to age and level of maturity. Early childhood development Refers to the cognitive, physical, language, motor, social and emotional development between 0 - 8 years of age. Early learning Any opportunity for the baby, toddler or child to interact with a person, place or object in their environment, Summary recognizing that every interaction (positive or negative, or absence of an interaction) is contributing to the child’s brain development and laying the foundation for later learning. (Child) Maltreatment The abuse and neglect of children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation, which results in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power. Maternal-infant bonding A process that includes the emotional tie of a mother to her infant, occurring in the first week or year of an infant’s life and that is influenced by signals and cues from the child as well as the maternal-driven processes. Nurturing care Characterized by a caregiving environment that is sensitive to children’s health and nutritional needs, responsive, emotionally supportive, and developmentally stimulating and appropriate, with opportunities for play and exploration and protection from adversities. Play Defined as being for its own sake (without a specific goal), voluntary, a special activity (out of the ordinary), enjoyed by participants, governed by rules (implicit or explicit) and imaginative. It can be solitary or social, and with or without objects. Young children acquire and consolidate developmental skills through playful interactions with people and objects. Improving early childhood development: WHO guideline – WHO development: childhood early Improving Positive parenting Incorporates anticipatory guidance for safety, education, development and the establishment of a caring and understanding relationship with one’s child. Parenting is not limited to biological parents, but extends to guardians or caregivers providing consistent care for the child. Responsive caregiving Incorporates anticipatory guidance for safety, education, development and the establishment of a caring and understanding relationship with one’s child. Parenting is not limited to biological parents, but extends to guardians or caregivers providing consistent care for the child. Responsiveness The capacity of the caregiver to respond contingently and appropriately to the infant’s signals. Stimulation Sensory information received from interactions with people and environmental variability that engages a young child’s attention and provides information; examples include talking, smiling, pointing, enabling and demonstrating, with or without objects. B 1 BACKGROUND ADE Enabling young children to achieve their full H QU LT A A TE developmental potential is a human right and a critical E N H U D T O R requisite for sustainable development. Evidence in the O I G T Lancet series Advancing early childhood development: IO N from science to scale (Lancet, 2017) highlights the O profound benefits of investing in early childhood P P development (ECD) for learning, productivity, health O R G and social cohesion along the life course. The series T U Components N I N highlighted the critical importance of the early years of nurturing V I I T care G and coined the term ‘nurturing care’ as a central tenet I E E S R of what is required to achieve optimal development, F A O C namely health, nutrition, security and safety, responsive R E E V I A caregiving and opportunities for early learning. S R L N Y O L P The Nurturing Care Framework (WHO, UNICEF & World E S A E R R Bank Group, 2018) was launched at the time of the N IN World Health Assembly in 2018 to provide a roadmap G SE CU ETY for action. The Framework builds on state-of-the-art RITY AND SAF evidence about how child development outcomes are influenced and how they can be improved by policies and interventions. Nurturing care is characterized Figure: Components of nurturing care by a stable environment that promotes health and Given the critical importance of enabling children to make optimal nutrition, protects children from threats, and the best start in life, the health sector has an important gives them opportunities for early learning, through role and responsibility to support nurturing care. Many affectionate interactions and relationships Figure( ). interventions for reproductive, maternal, newborn and It describes how a whole-of-government and a whole- child health (including for nutrition, mental health and HIV of-society approach can promote nurturing care prevention and care) have a direct impact on ECD. Moreover, for young children and outlines guiding principles, the health sector has access to families and caregivers strategic actions and ways of monitoring progress. during this period and therefore has specific opportunities. The Framework focuses on the period from pregnancy to age 3 within a life-course approach and addresses Until now, WHO has not had guidelines specifically on all relevant sectors, but with a spotlight on the interventions for improving ECD. Existing WHO guidelines health sector. related to neonatal care; infant and young child nutrition; environmental health; prevention and treatment of childhood ECD refers to the process of cognitive, physical, illnesses; violence and injury prevention; mental health; language, temperament, socioemotional and motor prevention of noncommunicable diseases; and support development of children that starts at the time of for children with developmental difficulties or disabilities, conception until 8 years of age. The earliest years refer to the importance of respective interventions for ECD. are especially important, being the time when the However, they do not address ECD-specific outcomes such brain develops rapidly; it is therefore a critical period as those related to responsive caregiving and early learning for the fetus and child to receive nurturing care. It is opportunities. also the period when the fetus and child are most sensitive to interventions (Lancet, 2017). Being at In order to provide clear and specific guidance on approaches the forefront of providing nurturing care, parents for improving ECD, WHO developed this guideline with a par- and other primary caregivers need to be supported ticular focus on responsive caregiving, opportunities for early through policies, information and services in order learning, and supporting the mental health of mothers. The to have knowledge, skills, time and material resources guideline provides global, evidence-informed recommenda- for appropriate child care. tions on approaches to improve ECD. B Background 1 RECOMMENDATIONS Enabling young children to achieve their full developmental potential is a human right and an essential requisite for sustainable development. It is primarily the family who provides the nurturing care that children need to develop in the earliest years, but many parents and other caregivers need support to put this into practice. This guideline provides direction for strengthening policies, services and programmes to better address ECD, and for countries to work towards related commitments made under the Sustainable Development Goals. PURPOSE OF THE GUIDELINE The scoping of the guideline and the prioritization of the outcomes were carried out by the Guideline This guideline provides global, evidence-informed Development Group (GDG) in September 2017. The recommendations on improving ECD. The objective development and finalization of the evidence-informed is to identify ECD-specific interventions and recommendations were conducted by the GDG, initially feasible approaches that are effective in improving in a meeting held in Geneva, Switzerland, 1 – 3 May 2018, developmental outcomes in children. and subsequently in a virtual meeting in September 2018. This new guideline focuses on the needs of both caregivers and young children because ECD is an AVAILABLE EVIDENCE AND outcome of healthy, nurturing interactions between REVIEW PROCESS them. It is relevant for all infants and young children The evidence to inform development of the guideline and their caregivers. was obtained from two systematic reviews that were The recommendations in this guideline are intended for conducted following the procedures of the WHO a wide audience, including policy-makers, development handbook for guideline development. The design of the agencies and implementing partners, district and review protocols was informed by the Lancet series sub-national health managers, health workers and Advancing early childhood development: from science nongovernmental organizations. to scale (Lancet,